A Multidimensional Risk Factor Analysis of Pediatric Urinary Tract Infections: Bridging Clinical, Behavioral, and Socioeconomic Determinants in an Iranian Pediatric Population

Neamatshahi, Mahboubeh; Razghandi, Marjan; Shahraeini, Ramin; Keykhosravi, Aghil

doi:10.22038/jpp.2026.97204.5706

A Multidimensional Risk Factor Analysis of Pediatric Urinary Tract Infections: Bridging Clinical, Behavioral, and Socioeconomic Determinants in an Iranian Pediatric Population

Document Type : original article

Authors

Mahboubeh Neamatshahi ¹

Marjan Razghandi ²

Ramin Shahraeini ³

Aghil Keykhosravi ⁴

¹ Community Medicine Department, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

² Student Research Committee, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

³ Department of Radiology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

⁴ Department of Pediatric Nephrology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

10.22038/jpp.2026.97204.5706

Abstract

Background: UTI remains a leading bacterial infection with potential for severe long-term morbidity, including renal scarring, hypertension, and CKD. The identification of modifiable risk factors is essential for targeted prevention. This study aimed to comprehensively evaluate factors associated with pediatric UTI in a hospital setting in Sabzevar, Iran.

Background: Urinary tract infection (UTI) remains a leading bacterial infection in children, with the potential for severe long-term morbidity, including renal scarring, hypertension, and chronic kidney disease. The identification of modifiable risk factors is essential for targeted prevention. This study aimed to comprehensively evaluate factors associated with pediatric UTI in a hospital setting in Sabzevar, Iran.
Methods: This case-control study enrolled 150 children under 16 years hospitalized with confirmed UTI and 150 age-matched controls hospitalized for non-UTI conditions. Data on demographic, socioeconomic, clinical, and behavioral variables were extracted from medical records and structured parental interviews. Statistical analyses included independent t-tests, Chi-square, and Fisher's exact tests, with significance set at p < 0.05. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated from univariate analyses.
Results: Among UTI cases, 120 (80%) were female and 30 (20%) male (mean age: 5.0 ± 1.8 years). Significant factors associated with UTI included female sex (p < 0.001), improper perineal hygiene (p < 0.001), uncircumcised status in males (p < 0.001), vesicoureteral reflux (VUR) (p < 0.001), constipation (p = 0.009), neurogenic bladder (p < 0.001), lack of toilet training (p < 0.001), tight underwear use (p < 0.001), bathtub use (p = 0.003), catheterization (p = 0.007), low socioeconomic status (SES) (p < 0.001), rural residence (p < 0.001), growth disorder (p < 0.001), prior UTI history (p < 0.001), family history of kidney stones (p = 0.001), and positive C-reactive protein (p < 0.001). Maternal education (p = 0.06) and labial adhesion (p = 1.00) showed no significant association.
Conclusion: Beyond established anatomical and physiological factors, socioeconomic status, hygiene practices, and behavioral patterns significantly contribute to pediatric UTI. Early identification and targeted educational interventions addressing these modifiable risks are critical to reducing recurrent infections and long-term renal complications.

Keywords

Children

Hygiene

Iran

Risk Factors

Socioeconomic Factors

Urinary Tract Infection

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